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General NPI Number Information
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NPI Number | 1285651976
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Entity Type | Organization
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Legal Business Name | INDIGO HEALTH CLINIC, PC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 9305 W THOMAS RD #285
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City | PHOENIX
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State | AZ
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Zip | 85037-3328
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Country | US
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Telephone | 623-849-1988
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Fax | 623-849-1981
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Provider Business Mailing Address
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Address Line | 8753 W IRMA LN
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City | PEORIA
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State | AZ
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Zip | 85382-6440
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Country | US
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Telephone | 623-849-1988
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Fax | 623-849-1981
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Authorized Official
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Title or Position | PRESIDENT
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Name | GOVINDA CHANDRA SATAPATHY
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Credential | MD
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Telephone | 623-849-1988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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